Predictors of timing of adjuvant chemotherapy in older women with hormone receptor-negative, stages II-III breast cancer.
Predictors of timing of adjuvant chemotherapy in older women with hormone receptor-negative, stages II-III breast cancer.
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DOI：
10.1007/s10549-011-1717-6
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发表时间：
2012-01
影响因子：
3.8
通讯作者：
Biddle AK
中科院分区：
文献类型：
--
作者：
Wheeler SB;Carpenter WR;Peppercorn J;Schenck AP;Weinberger M;Biddle AK
对癌症护理共识指南的遵守可能在医疗保健环境中存在很大差异，并导致癌症结局的差异。对于一些乳腺癌患者，遗漏辅助化疗或延迟开始化疗可能会导致癌症复发和死亡率的差异。我们研究了II期或III期激素受体阴性乳腺癌妇女的辅助化疗使用情况，以了解卫生系统和社会人口统计学与辅助化疗使用不足和延迟的相关性。我们使用监测流行病学和最终结果（SEER）-医疗保险相关数据来检查1994-2002年诊断为II期或III期激素受体阴性乳腺癌的6，678名65岁及以上女性的护理模式，索赔数据截至2007年。采用分层logistic回归分析来研究社会人口统计学和结构/组织卫生服务特征在解释辅助化疗启动差异中的潜在作用。指南推荐的辅助化疗的总体利用率在该人群中达到43%。年龄增加、合并症负担增加和低收入状态与4个月内开始化疗的几率较低相关，而淋巴结阳性、疾病更晚期和已婚与更高的几率相关（P < 0.05）。卫生系统相关的结构/组织特征和种族/族裔提供了很少的解释性见解。及时开始指南推荐的辅助化疗的比例较低，年龄、收入和合并症状态存在显著差异。基于这些发现，未来的研究应该寻求探索更微妙的原因，为什么老年妇女不接受化疗，为什么护理延误发生。
Adherence to consensus guidelines for cancer care may vary widely across health care settings and contribute to differences in cancer outcomes. For some women with breast cancer, omission of adjuvant chemotherapy or delays in its initiation may contribute to differences in cancer recurrence and mortality. We studied adjuvant chemotherapy use among women with stage II or stage III, hormone receptor–negative breast cancer to understand health system and socio-demographic correlates of under-use and delayed adjuvant chemotherapy. We used Surveillance Epidemiology and End Results (SEER)-Medicare linked data to examine the patterns of care for 6,678 women aged 65 and older diagnosed with stage II or stage III hormone receptor–negative breast cancer in 1994–2002, with claims data through 2007. Age-stratified logistic regression was employed to examine the potential role of socio-demographic and structural/organizational health services characteristics in explaining differences in adjuvant chemotherapy initiation. Overall utilization of guideline-recommended adjuvant chemotherapy peaked at 43% in this population. Increasing age, higher co-morbidity burden, and low-income status were associated with lower odds of chemotherapy initiation within 4 months, whereas having positive lymph nodes, more advanced disease, and being married were associated with higher odds (P < 0.05). Health system–related structural/organizational characteristics and race/ethnicity offered little explanatory insight. Timely initiation of guideline-recommended adjuvant chemotherapy was low, with significant variation by age, income, and co-morbidity status. Based on these findings, future studies should seek to explore the more nuanced reasons why older women do not receive chemotherapy and why delays in care occur.
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影响因子：
6.2
作者：
Haas, Jennifer S.;Earle, Craig C.;Williams, David R.
通讯作者：
Williams, David R.
影响因子：
6.2
作者：
Hébert-Croteau, N;Brisson, J;Pineault, R
通讯作者：
Pineault, R
影响因子：
45.3
作者：
Bickell, NA;Wang, JJ;Guth, AA
通讯作者：
Guth, AA
影响因子：
5.8
作者：
Giordano, Sharon H.;Fang, Shenying;Goodwin, James S.
通讯作者：
Goodwin, James S.
影响因子：
45.3
作者：
Elkin, Elena B.;Hurria, Arti;Panageas, Katherine S.
通讯作者：
Panageas, Katherine S.